starvation

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Starvation
Classification and external resources
A female child during the Nigerian-Biafran war of the late 1960s, shown suffering the effects of severe hunger and malnutrition.
ICD-10	T73.0
ICD-9	994.2
DiseasesDB	12415
MeSH	D013217

World map showing percentage of population suffering from hunger, World Food Programme, 2006

Starved Vietnamese man, who was deprived of food in a Viet Cong prison camp.

Starvation is a severe reduction in vitamin, nutrient, and energy intake, and is the most extreme form of malnutrition. In humans, prolonged starvation (in excess of 1–2 months) causes permanent organ damage^{[citation needed]} and, eventually, death. The term inanition refers to the symptoms and effects of starvation.

According to the World Health Organization, hunger is the gravest single threat to the world's public health.^[1] The WHO also states that malnutrition is by far the biggest contributor to child mortality, present in half of all cases.^[1]

Common causes

Child victim of the Holodomor.
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The basic cause of starvation is an imbalance between energy intake and energy expenditure; in starvation, more energy is spent than is taken in as food. This imbalance can arise in many situations, some of which include:

• Famine
• Poverty
• War
• Anorexia nervosa
• Bulimia nervosa
• Depression
• Coma
• Diabetes mellitus
• Digestive disease
• Overpopulation
• Fasting, when done without medical supervision and lasting more than a month.

Signs and symptoms

Individuals experiencing starvation lose substantial fat (adipose) and muscle mass as the body breaks down these tissues for energy. Catabolysis is the process (medical condition) of a body breaking down muscles and other tissues in order to keep vital systems working – vital systems such as the nervous system and heart muscle (myocardium). Catabolysis will not begin until there are no usable sources of energy coming into the body.^{[citation needed]} Vitamin deficiency is also a common result of starvation, often resulting in anemia, beriberi, pellagra, and scurvy. These diseases collectively may cause diarrhoea, skin rashes, edema, and heart failure. Individuals are often irritable and lethargic as a result.

Atrophy (wasting away) of the stomach weakens the perception of hunger, since the perception is controlled by the percentage of the stomach that is empty. Victims of starvation are often too weak to sense thirst, and therefore become dehydrated.

All movements become painful due to atrophy of the muscles, and due to dry, cracked skin caused by severe dehydration. With a weakened body, diseases are commonplace. Fungi, for example, often grow under the esophagus, making swallowing unbearably painful.

The energy deficiency inherent in starvation causes fatigue and renders the victim more apathetic over time. Interaction with one's surroundings diminishes as the starving person becomes too weak to move or even eat.

Psychological effects

The Buddha as an ascetic. Gandhara, 2-3rd century CE. British Museum.

Through several reports and studies, scientists have discovered that starvation has many psychological effects on a person, in addition to its physiological effects.^[2] The most extensive and informative study on starvation's psychological effects is called the Minnesota Starvation-Rehabilitation Experiment, which was carried out from 1944-1946. The subjects of this experiment were thirty-two fully informed volunteers, ages twenty to thirty-three.^[2] Subjects experienced three phases of the experiment: twelve weeks of control period, twenty four weeks of semistarvation, and then twelve weeks of rehabilitation. During the control experiments the subjects were given 3,492 calories, during the period of semistarvation the calories were decreased to 1,570, and during the period of rehabilitation they were re-increased to normal levels. During the period of semistarvation, subjects were fed foods most likely consumed in European famine areas.^[2] The results of the starvation experiment were tested in many ways. According to Josef Brozek, author of Psychology of Human Starvation and Nutritional Rehabilitation, studies "ranged from intelligence and personality tests through ratings to purely descriptive material, provided by the experimenters' notes and diaries kept by the subjects".^[2] According to subjects of the semistarvation experiment, tiredness was the worst effect of the low calorie intake, followed by appetite, muscle soreness, irritability, apathy, sensitivity to noise, and hunger pain.^[2] Standard personality tests revealed that the starving individuals experienced a large rise in the "neurotic triad" -- hypochondriasis, depression, and hysteria. Also, the subjects of the experiment noticed a marked decrease in the drive for activity, and a remarkable decrease in sex drive.^[2] In peer evaluations, other experiment subjects noted great changes in subjects' personalities during the period of semistarvation.; In interviews years later, subjects reported that they felt that they had not returned to normal by the end of the three month recovery period.^[3] Subjects' own estimates of the time it took for recovery ranged from two months to two years.^[3] Many subjects reported that they grossly overate and put on fat after the experiment due to the urge to eat.^[3]

Biochemistry

The body's glycogen stores are used up in about 24 hours. The level of insulin in circulation is low and the level of glucagon is very high. The main means of energy production is lipolysis. Gluconeogenesis converts glycerol into glucose and the Cori cycle converts lactate into usable glucose. Two systems of energy enter the gluconeogenesis, proteolysis provides alanine and lactate produced from pyruvate. Acetyl CoA produces dissolved nutrients (Ketone bodies), which can be detected in urine and are used by the brain as a source of energy.

In terms of insulin resistance, starvation conditions makes more glucose available to the brain.

Efforts

Treatment

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Starving patients can be treated, but this must be done cautiously to avoid refeeding syndrome.^[4]

Prevention

Supporting farmers in areas of food insecurity, through such measures as free or subsidized fertilizers and seeds, increases food harvest and reduces food prices.^[5][6] For example, in Malawi, almost five million of its 13 million people needed emergency food aid. Then, however, deep fertilizer subsidies and lesser ones for seed, abetted by good rains, helped farmers produce record-breaking corn harvests in 2006 and 2007, according to government crop estimates. Corn production leapt to 2.7 million metric tons in 2006 and 3.4 million in 2007 from 1.2 million in 2005, the government reported. The harvest also helped the poor by lowering food prices and increasing wages for farm workers. Malawi became a major food exporter, selling more corn to the World Food Program and the United Nations than any other country in Southern Africa. Over the 20 years prior to this change in policy by the World Bank and some rich nations Malawi depended on for aid have periodically pressed it to cut back or eliminate fertilizer subsidies, in the name of free market policies even as the United States and Europe extensively subsidized their own farmers. However, many, if not most, of its farmers are too poor to afford fertilizer at market prices. Proponents for helping the farmers includes the economist Jeffrey Sachs, who has championed the idea that wealthy countries should invest in fertilizer and seed for Africa’s farmers. He also conceived the Millennium Villages Project (MVP), which good seeds, fertilizers, and trains farmers how to use them. In a Kenyan village, where this was experimented, the project resulted in a tripling of its corn harvest, even though the village had previously had a cycle of hunger.

Organizations

Many organizations have been highly effective at reducing starvation in different regions. Aid agencies give direct assistance to individuals, while political organizations pressure political leaders to enact policies that will reduce famine and provide aid.

Hunger statistics

There were 923 million hungry people in the world in 2007, an increase of 80 million since 1990,^[7] despite the fact that the world already produces enough food to feed everyone - 6 billion people - and could feed double - 12 billion people.^[8]

Hunger mortality statistics

• On the average, a person dies every second as a result of hunger - 4000 every hour - 100 000 each day - 36 million each year - 58 % of all deaths (2001-2004 estimates).^[11][12][13]
• On the average, a child dies every 5 seconds as a result of hunger - 700 every hour - 16 000 each day - 6 million each year - 60% of all child deaths (2002-2008 estimates).^{[14][15][16][17][18]}

As capital punishment

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The starving Livilla refusing food.
From a drawing by André Castagne

Starvation has historically been used as a death sentence. From the beginning of civilization through to the Middle Ages people were immured, or starved to death.

In ancient Greco-Roman societies, starvation was sometimes used to dispose of guilty upper class citizens, especially erring female members of patrician families. For instance, in the year 31, Livilla, the niece and daughter-in-law of Tiberius, was discreetly starved to death by her mother for her adulterous relationship with Sejanus and for her complicity in the murder of her own husband, Drusus the Younger.

Another daughter-in-law of Tiberius, named Agrippina the Elder (a granddaughter of Augustus and the mother of Caligula) also died of starvation, in 33 (however, it is not clear whether she voluntarily starved herself to death or was forced to do so).

A son and a daughter of Agrippina were also executed by starvation for political reasons; Drusus Caesar, her second son, was put in prison in 33 and starved to death on the orders of Tiberius (he managed to stay alive for nine days by chewing the stuffing of his bed); Agrippina's youngest daughter, called Julia Livilla, was exiled on an island in 41 by her uncle, the emperor Claudius, and not much later, her death by starvation was arranged by the empress Messalina.

Execution by starvation was also a possible punishment for Vestal Virgins found guilty of breaking their vows.

Maximilian Kolbe, a Polish friar, offered his life to save another inmate sentenced to death in the Auschwitz concentration camp. He was starved along with another nine inmates. After two weeks of starvation he and three other inmates were still alive and executed with injections of phenol.

Ugolino della Gherardesca, his sons and other members of his family were immured in the Muda, a tower of Pisa, and starved to death in the thirteenth century. Dante, his contemporary, wrote about Gherardesca in his masterpiece The Divine Comedy.

In Sweden in 1317, the king Birger of Sweden had his two brothers locked up in the prison. They died a few weeks later because of starvation; their sentence was a punishment for a coup they staged several years earlier. This was called the Nyköping Banquet.

In Cornwall in 1671, there is a recorded case of a man by the name of John Trehenban from St Columb Major who was condemned to be starved to death in a cage at Castle An Dinas for the murder of two girls.

See also

References

External links

Wikimedia Commons has media related to: Starvation

• FAO - Understanding food insecurity
• FAO - What the new figures on hunger mean
• The Hunger Site - Help fight hunger world wide with just a click